Health Indicator Report of Immunizations - Pneumonia, Adults

Why Is This Important?

Pneumococcal disease is a serious infection of the lungs, blood, or outer lining of the brain. Each year it kills more people in the United States than all other vaccine preventable diseases combined. The most common form of serious pneumococcal disease among adults is pneumonia.
The clinical results of pneumonia and influenza are often indistinguishable and are grouped together as the 8th leading cause of death in Utah. Utah had a significantly lower rate of hospitalizations due to bacterial pneumonia than the U.S. each year from 2006 through 2011^1^.[[br]]
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====Pneumococcal Vaccines====
There are two pneumococcal vaccines that are licensed for use in the United States by the Food and Drug Administration (FDA):
* Pneumococcal conjugate vaccine (PCV13 or Prevnar 13)
* Pneumococcal polysacchardie vaccine (PPSV23 or Pneumovax23)[[br]]
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The pneumococcal conjugate vaccine (PCV13) is recommended for:
* all babies and children younger than 2 years old
* all adults age 65 years and older
* people with chronic illnesses (e.g., diabetes, heart, lung or kidney disease)
* people with compromised immune systems (including people with HIV)
* Those with cochlear implants or cerebrospinal fluid leaks
* Individuals who smoke cigarettes[[br]]
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The pneumococcal polysaccharide vaccine (PPSV23) is recommended for:
*All adults 65 years or older
* people with chronic illnesses (e.g., diabetes, heart, lung or kidney disease)
* people with compromised immune systems (including people with HIV)
* Those with cochlear implants or cerebrospinal fluid leaks
* Individuals who smoke cigarettes
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====Is it necessary to receive booster doses of pneumococcal vaccine?====
Those who should get a booster include:
* people age 65 and older who received the vaccine before age 65, if more than five years have passed
* people who have received a transplant
* people with chronic kidney disease
* people with compromised immune systems
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Adults who are 65 years or older and who have not previously received PCV13, should receive a dose of PCV13 first, followed 6 to 12 months later by a dose of PPSV23. If someone has already received one or more doses of PPSV23, the dose of PCV13 should be given at least 1 year after the most recent dose of PPSV23^2^.
A 2006 study published in the medical journal Clinical Infectious Diseases found that hospital patients who received the pneumococcal vaccine were 40 to 70 percent less likely to die than unvaccinated patients. In the study, vaccinated patients had a lower risk of respiratory failure, kidney failure, heart attack, and other complications. Vaccinated patients in the study also spent an average of two fewer days in the hospital^3^.[[br]]
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1. IBIS-PH. Health Indicator Report of Ambulatory Care Sensitive Condition: Bacterial Pneumonia Hospitalization Among Adults. Retrieved from: [http://ibis.health.utah.gov/indicator/view/ACS_PneuHosp.html][[br]]
2. Centers for Disease Control and Prevention (CDC). ''Pneumococcal Vaccination: Who Needs It?'' Retrieved from: [http://www.cdc.gov/vaccines/vpd-vac/pneumo/vacc-in-short.htm][[br]]
3. Vila-Crcoles, et al. Protective Effects of the 23-Valent Pneumococcal Polysaccharide Vaccine in the Elderly Population: The EVAN-65 Study. ''Clinical Infectious Diseases''. Retrieved from: [http://cid.oxfordjournals.org/content/43/7/860.full]

Chart

Data Table

Percentage of Adults 65+ Who Reported Having Ever Received Pneumococcal Vaccination, Utah and U.S., 1997-2015

Data Notes

Notes

Age adjusted to U.S. 2000 standard population. [[br]]
[[br]] Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf]

Other Views

Health Indicator Definition

Definition

Percentage of adults 65+ who reported receiving a pneumococcal vaccination at any point in their lifetime.

Numerator

Number of survey respondents age 65+ who reported receiving a pneomococcal vaccine anytime during their life.

Denominator

Number of survey respondents age 65+.

Health Objectives and Targets

Healthy People Objective IID-13.1:

Increase the percentage of noninstitutionalized adults aged 65 years and older adults who are vaccinated against pneumococcal diseaseU.S. Target: 90.0 percent

Current Outlook

How Are We Doing?

Lifetime pneumococcal vaccination rates for adults 65+ have significantly improved since 1997 when data were first collected on the BRFSS. The 1997 rate was 48.5% (95% confidence interval, 42.2%-54.8%) and by 2015 the rate had increased to 72.1% (69.6%-74.4%). However, due to a change in the BRFSS methodology in 2011, it is not possible to know if this is a significant change.

How Do We Compare With the U.S.?

In 2015, the pneumococcal vaccination rate for the U.S. (50 states plus D.C.) was 71.9%, while the Utah rate was 72.1%.

Health Improvement

Available Services

The Utah Immunization Program (UIP) started the Senior Outreach Initiative to cover pneumococcal vaccines (Zoster and PPV23) for adults aged 60+ who lack insurance or vaccine coverage under Medicare. The local health departments and a few specialty providers (homeless shelters, jails, etc.) are responsible for running the project in conjunction with the UIP.

Utah DOH

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